NPIMap

Organization Active NPI

Unbridled Healthcare System LLC

  • Psychiatric/Mental Health Registered Nurse
  • London, KY
National Provider Identifier
1184456717
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X
Legal business name
UNBRIDLED HEALTHCARE SYSTEM LLC
Practice address
222 N Main St
London, KY 40741-1367
Phone
(606) 215-3832
NPI assigned
Aug 14, 2024
Last updated
Aug 14, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
UNBRIDLED HEALTHCARE SYSTEMS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Terri Tye
Title
Billing
Phone
(606) 215-3832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X NU Primary

Addresses

Primary practice location

222 N Main St
London, KY 40741-1367

Mailing address

222 N Main St
London, KY 40741-1367
Phone (606) 215-3832

Other names 1

  • Unbridled Healthcare Systems, LLC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221003001081 KY Part B Supplier - Clinic/Group Practice 3274919097 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: London, KY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2293184Unbridled Healthcare222 North Main Street, London, KY 40741Certificate of waiverNov 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Unbridled Healthcare System2 organizations share this tax ID, including this one
Part of
Unbridled Healthcare System

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

222 N Main St
London, KY 40741
Phone (606) 215-3832

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1184456717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 N MAIN ST",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407411367",
            "telephone_number": "606-215-3832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 N MAIN ST",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407411367",
            "telephone_number": "606-215-3832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNBRIDLED HEALTHCARE SYSTEM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNBRIDLED HEALTHCARE SYSTEMS, LLC",
        "enumeration_date": "2024-08-14",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "TYE",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "606-215-3832"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Unbridled Healthcare Systems, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in London, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.